在阅读一篇医学杂志文章之时
One of the critical questions to ask
我们需要问及的一个重要问题是
when reading a medical journal article is
是谁资助了这项研究？
who funded the study?
在大多数杂志中
In most journals,
研究者们都被要求注明他们的基金来源
researchers are required toidentify their sources of funding.
但这有什么问题呢？
So what’s the problem?
就是 研究者们可以隐瞒财政支持的真实来源
Well,researchers can obscurethe true origin of financial support:
他们掩盖 隐瞒这些来源
they can hide it, disguise it,
甚至通过幌子组织进行洗钱
or even launder the money through a front group.
举个案例
Case in point,
一项低估肺癌风险的研究
a study downplaying the risk of lung cancer
一部分是由肺癌早期检测 预防和治疗基金会资助的
funded in part by the Foundation for Lung Cancer Early Detection, Prevention,and Treatment.
这听起来感觉没什么大不了
That doesn’t sound so bad
直到你知道
until you realize
基金会接受了一家香烟公司的几百万美元资助
it’s underwritten by millions from a tobacco company.
由于研究人员没有义务披露
See, there’s no obligation to… to disclose
一笔资金来源的资金来源
a funding source’s source of funding,
公司可以规避财务披露的要求
This allows companies to evade financial disclosure requirements,
并让资金的追踪定位变得难上加难
and make it harder to follow the money trail.
为什么资金来源这么重要？
Why does the funding source matter?
有八项文献综述分析了逾千项研究 结果一致表明
Every single one of eight reviews covering over a thousand studies
由产业资助的研究
found that research funded by industry
更有可能得出有利于该产业的结论
is more likely to make conclusions that are favorable to industry.
例如
For example,
有关二手烟对健康的影响的综述研究
why do some review articles on the health effects of second hand smoke
为什么会得出不一致的结论呢？
reach different conclusions than others?
唯一的因素就是 作者是否隶属于烟草产业
The only factor was whether an author was affiliated with the tobacco industry.
这种发现真是让人不安啊！
This is a disturbing finding!
它表明了
It suggests that,
在客观的 纯粹的科学领域里
far from conflict of interest being unimportant
利益冲突不但非常重要
in the objective and pure world of science.
而且它可能就是决定许多研究结果的主因
It may be the main factor determining the result of many studies.
但你不会知道这一点 因为77%的作者并未披露资金来源
Not that you’d know because 77% of authors failed to disclose the sources of funding.
而且还有另一个问题就是：
And that’s another problem:
既然披露资金来源的责任全由作者承担
the responsibility to disclose funding sources is left entirely up to the authors,
那么又会有多少研究者揭露真相呢？
so how many researchers divulge the truth?
显然 丹麦颁布的一项法律
Evidently a law was passed in Denmark
要求医生在与产业合作时进行登记
requiring physicians to register any time they worked with industry,
以便于让研究者相互参照他们所发表的研究
which allowed researchers to cross-reference the studies they published
看看他们的可信度有多高
to see how honest they were.
但是在48%的情况下
And 48 % of the time,
研究中的利益冲突并未被披露
the conflicts of interest were not disclosed
而这增强了
reinforcing the perception that
医生对利益冲突不以为然的观念
physicians simply don’t take conflict of interest seriously,
或者说至少丹麦医生是这样
or at least Danish physicians.
那美国医生是怎样的呢？
What about the US?
直到这项研究发表后
We didn’t know
我们才有所了解
until this study was published.
在过去 当美国医生声称不存在利益冲突时
Historically, there have been no means of confirmation or verification
我们无从进行确认和查证
when an American doctor said they had no conflicts of interest.
但是就在2007年
But then in 2007,
髋膝关节置换器材公司
hip and knee replacement companies
因为给骨科医生非法回扣
were forced to pay hundreds of millions of dollars in fines
而被罚了好几百万美元
for giving orthopedic surgeons at illegal kickbacks.
很多骨科医生的决策是以利润为依据的
Many orthopedic surgeons made decisions predicated on how much money they could make,
他们会选择出价最高的器材做关节植入
choosing which device to implant by going to the highest bidder.
司法部曾说：“我们希望医生的决策考虑的是病人的利益
“We expect doctors to make decisions based on what is in the best interests of their patients,”
而不是自己的利润”
said the Department of Justice, “not the best interests of their bank accounts.”
和解方案的一部分
And part of the settlement
是让公司将他们对医生的支付款项公之于众
was that they would have to make public all the payments they made to physicians.
这些记录被公布出来 实在很难得
The release of those records offered a rare opportunity
因为我们可以知道医生们是否披露了真相
to see if physicians were tellingthe truth on disclosure forms.
结果超过一半的支付费用始终都未被披露
And…lo and behold, more than half of payments were not disclosed
总计高达数百万美元
totaling millions of dollars.
这是外科医生和医疗器械公司的情况
Now this was for surgeons and medical device companies.
那么医生和药品公司是什么情况呢？
What about doctors and drug companies?
药品公司也被迫披露他们付钱给了谁
The same thing happened where drug companies were forced to disclose
结果同样的情况出现了
who they were paying off.
研究者分析了拿钱最多的医生的文章
They looked at the publications of the doctors that got the most money,
他们赚了至少10万美金
at least 100 grand.
结果发现他们比外科医生更糟糕
and they were worse than the surgeons.
在69%的案例中
In 69 % of the cases,
他们并未披露自己与所在产业的关联
they fail to disclose their industry tie.
问题是
The problem is
我们以为研究者会如实反映事实
that we just assume researchers are going to be honest and tell the truth.
但这些发现却表明了
But these findings suggest
利益冲突披露的准确性和完整性
that the accuracy and completenessof conflict-of-interest disclosures
不是理所当然的
can not be assumed.
因此 即便有文章说不存在利益冲突时
So even when a paper says no conflict of interest,
谁知道这是不是真的呢？
who knows if it’s really true?
《新英格兰医学杂志》的资深主编
Long-time editor-in-chief of the New England Journal of Medicine
写了一篇犀利的文章来批评
wrote a scathing piece on drug companies and doctors
获得药品公司支付数十万美元而不披露的医生
who failed to disclose hundreds of thousands of dollars
涉事的公司包括葛兰素史克公司
from drug companies like Glaxo Smith Kline,
该公司因为贿赂和隐瞒数据
which had been fined literally billions of dollars
被处以数十亿美元的罚款
for things like bribes and suppressing data.
当研究结果不利于公司的业务时
When they got results that werecommercially unacceptable,
公司就把这些研究隐藏起来
they just buried them.
但对于药品公司来说 数十亿美元的罚款
Billions in fines, but for drug companies
只是公司的运营成本罢了
that may just be the cost of doing business.
虽然药品行业中的很多做法应受谴责
As reprehensible as many drug industry practices are,
但是医疗行业可能更难辞其咎
the medical profession may be even more culpable.
我的意思是
I mean
药品公司注重利润是理所当然的
you expect drug companies to prioritize the bottom line,
但或许
but maybe
我们对医疗行业的要求应该更高
we should expect more from the healing profession.